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Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

  • Tsai, Huang-Wen ;
  • Hsieh, Fu-Chien ;
  • Chang, Chih-Chun ;
  • Su, Ming-Jang ;
  • Chu, Fang-Yeh ;
  • Chen, Kuo-Hsin ;
  • Jeng, Kuo-Shyang ;
  • Chen, Yun
  • Published : 2015.12.03

Abstract

Background: Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation. Materials and Methods: From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis. Results: A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were $11.6{\pm}1.8g/dL$ and $11.7{\pm}1.7g/dL$, respectively; and the nadir Hb level post operation and the final Hb level before discharge were $8.3{\pm}1.6g/dL$ and $10.2{\pm}1.6g/dL$, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation. Conclusions: Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.

Keywords

Peri-operative transfusion;red blood cells;liver transplantation;kidney transplantation;small intestine

References

  1. Carpenter CB (1990). Blood transfusion effects in kidney transplantation. Yale J Biol Med, 63, 435-43.
  2. dallas t, welsby i, bottiger b, et al (2015). bloodless orthotopic heart transplantation in a jehovah's Witness. A A Case Rep, 4, 140-2. https://doi.org/10.1213/XAA.0000000000000067
  3. Devi AS (2009). Transfusion practice in orthotopic liver transplantation. Indian J Crit Care Med, 13, 120-8. https://doi.org/10.4103/0972-5229.58536
  4. Fonseca-Neto OC, Miranda LE, Batista TP, et al (2012). Postoperative kidney injury does not decrease survival after liver transplantation. Acta Cir Bras, 27, 802-8. https://doi.org/10.1590/S0102-86502012001100010
  5. Garcia JH, Coelho GR, Feitosa Neto BA, et al (2013). Liver transplantation in Jehovah's Witnesses patients in a center of northeastern Brazil. Arq Gastroenterol, 50, 138-40. https://doi.org/10.1590/S0004-28032013000200023
  6. George DL, Arnow PM, Fox AS, et al (1991). Bacterial infection as a complication of liver transplantation: epidemiology and risk factors. Rev Infect Dis, 13, 387-96. https://doi.org/10.1093/clinids/13.3.387
  7. Gu YH, Du JX, Ma ML (2012). Sirolimus and non-melanoma skin cancer prevention after kidney transplantation: a metaanalysis. Asian Pac J Cancer Prev, 13, 4335-9. https://doi.org/10.7314/APJCP.2012.13.9.4335
  8. Guo JR, Xu F, Jin XJ, et al (2014). Impact of allogenic and autologous transfusion on immune function in patients with tumors. Asian Pac J Cancer Prev, 15, 467-74. https://doi.org/10.7314/APJCP.2014.15.1.467
  9. Hernandez-Navarrete LS, Hernandez-Jimenez JD, Jimenez- Lopez LA, et al (2013). Experience in kidney transplantation without blood transfusion: kidney transplantation transfusionfree in Jehovah's Witnesses. First communication in Mexico. Cir Cir, 81, 450-3.
  10. Li WH, Chen YJ, Tseng WC, et al (2012). Malignancies after renal transplantation in Taiwan: a nationwide populationbased study. Nephrol Dial Transplant, 27, 833-9. https://doi.org/10.1093/ndt/gfr277
  11. Liu L, Wang Z, Jiang S, et al (2013). Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PloS one. 8, 64261. https://doi.org/10.1371/journal.pone.0064261
  12. Massicotte L, Sassine M-P, Lenis S, et al (2005). Survival rate changes with transfusion of blood products during liver transplantation. Can J Anaesth, 52, 148-55. https://doi.org/10.1007/BF03027720
  13. Massicotte L, Denault AY, Beaulieu D, et al (2012). Transfusion rate for 500 consecutive liver transplantations: experience of one liver transplantation center. Transplantat, 93, 1276-81. https://doi.org/10.1097/TP.0b013e318250fc25
  14. McCluskey SA, Karkouti K, Wijeysundera DN, et al (2006). Derivation of a risk index for the prediction of massive blood transfusion in liver transplantation. Liver Transpl, 12, 1584-93. https://doi.org/10.1002/lt.20868
  15. Meng J, Lu XB, Tang YX, et al (2013). Effects of allogeneic blood transfusion in patients with stage II colon cancer. Asian Pac J Cancer Prev, 14, 347-50. https://doi.org/10.7314/APJCP.2013.14.1.347
  16. Nemes B, Sarvary E, Sotonyi P, et al (2005). Factors in association with sepsis after liver transplantation: the Hungarian experience. Transplant Proc, 37, 2227-8. https://doi.org/10.1016/j.transproceed.2005.03.067
  17. Ozier Y, Tsou MY (2008). Changing trends in transfusion practice in liver transplantation. Curr Opin Organ Transplant, 13, 304-9. https://doi.org/10.1097/MOT.0b013e3282faa0dd
  18. Pandey CK, Singh A, Kajal K, et al (2015). Intraoperative blood loss in orthotopic liver transplantation: The predictive factors. World J Gastrointest Surg, 7, 86-93. https://doi.org/10.4240/wjgs.v7.i6.86
  19. Pilar Solves, Nelly Carpio, Federico Moscardo, et al (2015). Transfusion Management and Immunohematologic Complications in Liver Transplantation: Experience of a Single Institution. Transfus Med Hemother, 42, 8-14. https://doi.org/10.1159/000370260
  20. Ramos E, Dalmau A, Sabate A, et al (2003). Intraoperative red blood cell transfusion in liver transplantation: influence on patient outcome, prediction of requirements, and measures to reduce them. Liver Transpl, 9, 1320-7. https://doi.org/10.1016/jlts.2003.50204
  21. Rana A, Petrowsky H, Hong JC, et al (2013). Blood transfusion requirement during liver transplantation is an important risk factor for mortality. J Am Coll Surg, 216, 902-7. https://doi.org/10.1016/j.jamcollsurg.2012.12.047
  22. Scornik JC, Schold JD, Bucci M, et al (2009). Effects of blood transfusions given after renal transplantation. Transplantat, 87, 1381-6. https://doi.org/10.1097/TP.0b013e3181a24b96
  23. Sugita S, Sasaki A, Iwaki K, et al (2008). Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: a retrospective study. Eur J Surg Oncol, 34, 339-45. https://doi.org/10.1016/j.ejso.2007.02.010
  24. van der Bilt JD, Livestro DP, Borren A, et al (2007). European survey on the application of vascular clamping in liver surgery. Dig Surg, 24, 423-35. https://doi.org/10.1159/000108325
  25. Wang SC, Shieh JF, Chang KY, et al (2010). Thromboelastographyguided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial. Transplant Proc, 42, 2590-3. https://doi.org/10.1016/j.transproceed.2010.05.144
  26. Wang YL, Jiang B, Yin FF, et al (2015). Perioperative Blood Transfusion Promotes Worse Outcomes of Bladder Cancer after Radical Cystectomy: A Systematic Review and Meta- Analysis. PLoS One, 10, 130122.
  27. Xia VW, Du B, Braunfeld M, et al (2006). Preoperative characteristics and intraoperative transfusion and vasopressor requirements in patients with low vs. high MELD scores. Liver Transpl, 12, 614-20. https://doi.org/10.1002/lt.20679
  28. Xing YL, Wang YC (2014). Influence of autologous and homologous blood transfusion on interleukins and tumor necrosis factor-$\alpha$ in peri-operative patients with esophageal cancer. Asian Pac J Cancer Prev, 15, 7831-4. https://doi.org/10.7314/APJCP.2014.15.18.7831
  29. Yunus M, Aziz T, Mubarak M (2012). Posttransplant malignancies in renal transplant recipients: 22-years experience from a single center in Pakistan. Asian Pac J Cancer Prev, 13, 575-8. https://doi.org/10.7314/APJCP.2012.13.2.575

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